Grade Of Portal Hypertension Research Articles

Porto-sinusoidal vascular disease with portal hypertension versus liver cirrhosis: differences in imaging features on CT and hepatobiliary contrast-enhanced MRI.

To differentiate the computed tomography (CT) and magnetic resonance imaging (MRI) features of porto-sinusoidal vascular disease (PSVD) and liver cirrhosis (LC). In this retrospective case-control study of patients with PSVD matched in a 1:3 ratio with LC patients according to liver function, initial diagnosis and time to final diagnosis were analyzed. Imaging features on CT and the parenchymal enhancement on hepatobiliary phase of hepatobiliary agent-enhanced MRI (HBA-MRI) were compared using a generalized linear mixed model. Focal hepatic lesions in the PSVD group were analyzed. In total, 43 PSVD patients and 129 LC patients were included. Among PSVD patients, 72.1% were initially misdiagnosed with LC. PSVD patients had a longer diagnostic delay than LC patients (32months vs. 4months; p < 0.001). Liver surface nodularity was less common in the PSVD group than in the LC group (16.3% vs. 89.2%, p < 0.001). Increased caudate-to-right lobe ratio, heterogeneous parenchymal enhancement, and portal vein abnormalities were more frequently noted in the PSVD group than in the LC group (all p < 0.001). The grade of portal hypertension was significantly higher in the PSVD group than in the LC group (p < 0.001), and they also had brighter parenchymal enhancement during the hepatobiliary phase of HBA-MRI (p < 0.001). In the PSVD group, 14% patients had at least one focal hepatic lesion, primarily a focal nodular hyperplasia (FNH)-like nodule. Some imaging features on CT and HBA-MRI can distinguish PSVD from LC. Benign focal lesions, most commonly FNH-like nodules, can develop in PSVD.

Relationship between Laennec histological subclassification of cirrhosis and clinical stage, grade of portal hypertension and liver stiffness

Relationship between Laennec histological subclassification of cirrhosis and clinical stage, grade of portal hypertension and liver stiffness

New frontiers in liver resection for hepatocellular carcinoma.

SummaryLiver resection is one of the main curative options for early hepatocellular carcinoma (HCC) in patients with cirrhosis and is the treatment of choice in non-cirrhotic patients. However, careful patient selection is required to balance the risk of postoperative liver failure and the potential benefit on long-term outcomes. In the last decades, improved surgical techniques and perioperative management, as well as better patient selection, have enabled the indications for liver resection to be expanded. In this review, we aim to describe the main indications for liver resection in the management of HCC, its role compared to percutaneous ablation and liver transplantation in the therapeutic algorithm, as well as the recent advances in liver surgery that could be used to improve the prognosis of patients with HCC.

Comparison Between Swan-Ganz Catheter and Minimally Invasive Hemodynamic Monitoring During Liver Transplantation: Report of a Monocentric Case Series

IntroductionThe aim of the present investigation was to retrospectively evaluate the utilization of Swan-Ganz catheter during orthotopic liver transplantation as opposed to FloTrac/Vigileo in selected cases, comparing a number of clinical outcomes across postoperative hospitalization. Materials and methodsBefore 2015 all recipients received pulmonary artery catheter (Swan-Ganz group, n = 109). After 2015 Swan-Ganz was used only if coronary artery disease or high-grade portal hypertension or Child-Pugh C were present; the remaining recipients were assigned to FloTrac/Vigileo monitoring (Mini group, n =100). A number of clinical outcomes were considered. ResultsDonor’s Risk Index was similar between groups (median value 1.7, P = .27). Anthropometric characteristics of the recipients were similar in the 2 groups. There were no significant differences in the proportion of patients with Child-Pugh C (P = .873), coronary artery disease (P = .18), and grade of portal hypertension (P = .733). The Model for End-Stage Liver Disease score was slightly higher in the Mini group: (9 [7-11] vs 9 [8-12], Swan-Ganz vs Mini, respectively, P < .035). Swan-Ganz utilization decreased over time (92% vs 26%, Swan-Ganz vs Mini, P < .001). Upon admission to the intensive care unit, patients of the Mini group presented a higher SAPS II score with similar values of Sequential Organ Failure Assessment score. Days on mechanical ventilation were similar between groups. The incidence of graft failure was similar between groups (2% vs 5%, Swan-Ganz and Mini group respectively, P = .376). Recipients’ hospital length of stay was similar (13 days [11-19] vs 14 [11-20], P < .083). ConclusionsOur data suggest that the intraoperative utilization of FloTrac/Vigileo for oncologic patients with low grade end stage liver disease is reasonably safe.

Histological subclassification of cirrhosis using the Laennec fibrosis scoring system correlates with clinical stage and grade of portal hypertension

Further histological subclassification of cirrhosis may be useful because of heterogeneity of severity within cirrhosis. We aimed to determine the relationship between histological subclassification and clinical stage of cirrhosis as well as grade of portal hypertension. One hundred-twenty-three biopsy-proven cirrhosis patients, whose clinical stage of cirrhosis and hepatic venous pressure gradient (HVPG) could be estimated, were included in this prospective study. Histology of cirrhosis was blindly subclassified using the Laennec fibrosis scoring system semi-quantitatively without knowledge of the clinical stage or the HVPG results. The Laennec system subclassifies cirrhosis as mild - thin septa, moderate - at least two broad septa, and severe - at least one very broad septum or many minute nodules. Clinical stages were determined by the presence or absence of varices, ascites, and variceal hemorrhage. Biological and laboratory data were also collected. Alcohol intake was the most common cause of cirrhosis in this cohort (87, 70.7%). Histology of cirrhosis subclassified using the Laennec scoring system significantly correlated with both the clinical stage of cirrhosis (p < 0.001) and HVPG (mild: 8.1 ± 2.6 mm Hg, moderate: 12.4 ± 3.3mm Hg, severe: 16.3 ± 4.0 mm Hg, p < 0.001). With higher grades of histological subclassification of cirrhosis, increased frequency in both severe portal hypertension (HVPG ≥ 12 mm Hg) and episodes of variceal hemorrhage were observed (p < 0.001). Histological subclassification of cirrhosis by the Laennec fibrosis scoring system is tightly correlated with both the clinical stage of cirrhosis and grade of portal hypertension. This suggests that cirrhosis should be subclassified into different stages according to its histological severity.

Prevalence of ‘deep’ rectal varices in patients with cirrhosis: an EUS‐based study

Endoscopic ultrasound (EUS) permits identification of dilated veins of the intrinsic rectal venous system (deep varices) in portal hypertension. The aim of this cross-sectional study was to assess the prevalence of, and risk factors for, deep rectal varices, using EUS. A cohort of 96 patients with cirrhosis was studied. Both routine rectoscopy and rectal EUS were performed. Deep varices were assessed as peri-rectal and para-rectal. A three-grade scale was used to assess the size of the deep varices. On rectoscopic examination, congestive rectopathy was seen in 11(11%) patients, blue veins in 36(38%) and rectal varices in 13 (14%). On EUS, deep varices were seen in 49(51%) subjects. Small peri-rectal varices were seen in 29 (30%) patients and large peri-rectal varices in 10 (10%). Small para-rectal varices were seen in 22 (23%) patients and large para-rectal in 13 (14%). Of the 83 patients without rectal varices on rectoscopy, 39 (47%) had varices detectable with EUS. Patients with large deep varices had more advanced liver disease and significantly thicker rectal wall. They did not differ from other patients in terms of the other analysed factors. EUS permits identification of deep rectal varices in a large proportion of patients without detectable varices on rectoscopy. Unlike in previous study, we found that the presence of large deep rectal varices correlates with the degree of liver failure and thickness of rectal wall but not with the grade of portal hypertension in the oesophagus or the stomach. The clinical significance of these varices is uncertain and requires further study.

Splanchnic Hemodynamics in Cirrhotic Patients: Relationship to Esophageal Varices and the Severity of Hepatic Failure

Purpose: The relationship between splanchnic hemodynamics, liver function, and esophageal variceal grading in cirrhosis remains unclear. The aim was to determine the value of quantitative Doppler parameters of splanchnic hemodynamics in assessing esophageal variceal (OV) grading, severity of liver insufficiency and presence of ascites. Methods: The following parameters were performed for 153 cirrhotics and 30 controls: portal vein (PV) and splenic vein (SV) – cross sectional area (CSA), mean velocity (MV), flow volume (FL), PV congestive index; hepatic artery, splenic artery (SA) and superior mesenteric artery (SMA) pulsatility index (PI) and resistive index (RI); liver vascular index (LVI), modified LVI (M-LVI), portal hypertension index (PHI), portal inflow (P-flow) and collateral inflow (C-flow). Results: All parameters differentiated between control and cirrhotics except PV-FL and SV-FL which were significantly lower only in advanced cirrhosis (Child C). SMA-PI, PHI, P-flow and C-flow were significantly different among various Child classes. PV-MV was significantly lower in small OV compared to other groups. All parameters were significantly different in large OV except PV-FL, SMA-PI and –RI. PV-FL, SA-PI, SMA-RI, LVI, M-LVI, P-flow and C-flow were significantly different in gastric varices group compared to other groups. All parameters were significantly different in ascitic than non-ascitic except PV-CSA, SMA-PI and -RI. Conclusion: Splanchnic Doppler parameters are significantly related to stages of liver damage, grade of portal hypertension and presence of ascites, and may therefore be used as surrogate markers. We recommend an optimal scoring system with Doppler parameters integrated for diagnosis and staging of cirrhosis and portal hypertension.

Plasma endothelin-1 concentrations are elevated in acute hepatitis and liver cirrhosis but not in chronic hepatitis

We measured plasma endothelin-1 (ET-1) concentrations in 20 healthy controls and 63 patients with liver diseases including 9 cases of acute hepatitis (AH), 14 cases of chronic hepatitis (CH), 24 cases of liver cirrhosis (LC), 11 cases of hepatocellular carcinoma with LC (HCC), 3 of primary biliary cirrhosis and 2 of idiopathic portal hypertension. ET-1 levels in AH (5.07 +/- 2.54 pg/ml, mean +/- SD), LC (3.71 +/- 1.17) and HCC (3.08 +/- 0.93) were significantly higher than those in healthy controls (2.18 +/- 0.37). ET-1 levels in AH, LC and HCC were also significantly higher than those in CH (2.05 +/- 0.61). ET-1 levels showed negative correlations with serum albumin levels and Ch-Ease activities, and positive correlations with serum bilirubin levels, AST and ALT activities. However, there was no correlation between plasma ET-1 concentrations and concentrations of serum thrombomodulin which is known to be a marker of injured vascular endothelial cells. In cirrhotic patients, ET-1 levels were significantly influenced by the presence of ascites. The results of the present study suggest that plasma ET-1 concentrations may be a useful clinical indicator for use in the follow-up of patients with chronic liver diseases, e.g., progression from CH to LC, and change in grade of portal hypertension and decompensation in LC.